title: Assessment of complications according to the Clavien-Dindo classification after distal pancreatectomy.
abstract: BACKGROUND
  The absence of a definition and a widely accepted ranking system to classify surgical complications has hampered proper interpretation of the surgical outcome.
  
  
  METHODS
  Sixty-one patients undergoing distal pancreatectomy.
  
  
  METHODS
  The complications were classified according to the Clavien-Dindo classification; each grade was evaluated regarding the length of the postoperative stay and was compared to the most important complications.
  
  
  RESULTS
  Thirty (49.2%) patients had no complications; out of the thirty-one (50.8%) patients with complications, 9 (14.5%) had grade I, 15 (24.6%) had grade II, 6 (9.8%) had grade III, and 1 (1.6%) had grade IV. There were no postoperative deaths (grade V). A progressive increase in the length of hospitalization from patients with no complications to those having grade IV (P < 0.001) was noted. Postoperative pancreatic fistula and postpancreatectomy hemorrhage rates did not significantly increase from Clavien-Dindo grade I to grade IV (P = 0.118 and P = 0.226, respectively). The severity of a postpancreatectomy hemorrhage, instead, was positively related to the grade of the Clavien-Dindo classification (P = 0.049) while postoperative pancreatic fistula resulted near the significant value (P = 0.058).
  
  
  CONCLUSIONS
  The Clavien-Dindo classification is a simple way of reporting all complications following distal pancreatectomy. It allows us to distinguish a normal postoperative course from any deviation and the severity of complications and it may be useful for comparing postoperative morbidity between different pancreatic centers.
authors.affiliation: Department of Surgery, Alma Mater Studiorum - University of di Bologna, S.Orsola-Malpighi Hospital. Bologna, Italy. riccardo.casadei@aosp.bo.it
authors.forename: Riccardo
authors.initials: R
authors.lastname: Casadei
authors.forename: Claudio
authors.initials: C
authors.lastname: Ricci
authors.forename: Raffaele
authors.initials: R
authors.lastname: Pezzilli
authors.forename: Lucia
authors.initials: L
authors.lastname: Calculli
authors.forename: Marielda
authors.initials: M
authors.lastname: D'Ambra
authors.forename: Giovanni
authors.initials: G
authors.lastname: Taffurelli
authors.forename: Francesco
authors.initials: F
authors.lastname: Minni
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D010180:Pancreatectomy / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000145:classification* / Q000209:etiology / Q000473:pathology*; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index